This site is intended for health professionals only

Dazed and confused by the NHS changes?

Marilyn Eveleigh
Consultant Editor

As I get older, I've noticed a growing impatience and intolerance of poor decision making - certainly not of change itself. Maybe I've become cynical that changes will be for the better because things are often worse first. Nowhere is this more evident than in the NHS - and there have been some obvious examples recently.
The news that the government now wants GPs to have extended surgery hours in the evening and at weekends is a prime example of how muddled and confused healthcare planners appear. Only three years ago such services were abandoned as part of the 2003 GMS Contract - as was the commitment of GPs to provide a 24-hour cover for registered patients. Now, apparently, an extensive national patient consultation ending in a citizen's panel last November in Birmingham revealed this is actually what patients want. Of course it is what they want - they want the services back! They also want cottage hospitals to be retained because they are local, more accessible and not impersonal. The message is that if PCTs think their populations need such coverage, they can purchase the services - so PCTs can commission GPs and their staff to provide what they did such a short time ago. But is there any new money?
Then there is the reconfiguration of PCTs and Strategic Health Authorities - again! In 2003 Health Authorities became Primary Care Trusts, which would allow services to be tailored to local needs. More than 300 new PCTs were supported by new Boards, a Professional Executive Committee, a Director of Public Health, a Financial Director, a Director of Nursing, etc, who commission and provide care in far smaller identified localities. Now three years later this model is being scrapped - DH reviews of public health outcomes and economies of scale have determined that there is to be a rationalisation and amalgamation into far fewer but bigger PCTs. There were a lot of mutterings at their conception that PCTs were too small, and new remodelling will make them look very similar to the organisations they originally replaced.
A bombshell last summer in a DH circular directing PCTs to separate their service provider function from their commissioning role by 2008 has now been toned down. A slowdown on change this time! The latest future of primary care is outlined in the recent White Paper Our health, our care, our say.(1) It introduces the concept that private companies, charities or private individuals can tender to provide NHS services. It has great potential to reduce waiting times, minimise or eliminate admission to acute hospitals, introduce healthy competition and push up care standards. It sounds good in theory - but the reality is that staff who have traditionally provided such care feel insecure and destabilised. Who will their employer be? What if they do not want to leave the NHS? How will pensions be affected?
I'm particularly concerned with the additional pressure that reorganising health services puts on frontline NHS staff. Managers and DH leaders may consider the direction they herald is best; but the explanation and excuses for reorganised or withdrawal of services is given by frontline staff to those who will be profoundly affected - patients.
Worse than that, it is difficult explaining ''it's for the best'', "it's more effective'' and "evidence has shown that ..." when you don't understand why or even believe in the changes. How do you reassure your patients when you don't feel reassured yourself? Which reminds me - have you all had your Agenda for Change assimilation completed? Are you happy with the result or making an appeal? This has been just another pressure and uncertainty for NHS staff in their already pressurised and uncertain world. And it's making me a grumpy old woman …


  1. Department of Health. Our Health, Our Care, Our Say. Available from